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The thinking doctor’s guide to placebos

BMJ 2008; 336 doi: https://doi.org/10.1136/bmj.39564.454502.C2 (Published 01 May 2008) Cite this as: BMJ 2008;336:1020

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An excellent and innovative perspective on placebo

Congratulations. This is indeed a thinking doctor's guide. What is highlighted by this article is that the "placebo" response is not a sham response - the treatment might be sham (a dummy drug, or pretend acupuncture, or whatever) but the response is REAL. It's such a shame that this phenomenon has been ignored for so long because people have dismissed it as unreal or, at best, insignificant. As you rightly point out, the response can be significant and can be long lasting. In other words it can bring real value to the patient - and with minimal potential for harm and very small cost.

One point I would like to make, however, is that for each patient who receives, say, a chemical drug, it is impossible to say how much of the outcome will be due to the chemical and how much to this mechanism (whatever this mechanism is!), so, as doctors, we are never in a position of being able to say to a patient - the benefit you will get from this drug will be due to the effects of the chemicals. In other words, in every single intervention, for full disclosure, a doctor should make clear that the outcomes may be due in whole, or in part, to the placebo effect.

There's a misunderstanding on the part of many doctors and patients that there are drugs which work and placebos which don't. The world is not like that. ALL interventions will have some degree of specific effect and some of placebo.

Ethically, shouldn't we seek to maximise our use of this effect for every single patient?

Competing interests: None declared

Competing interests: No competing interests

02 May 2008
Robert W Leckridge
Locum Consultant
Glasgow Homeopathic Hospital. G12 0XQ